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REQUEST TO RELEASE INFORMATION (INDEPENDENT AGENTS) TO (Do Not Write Above This Line For Gaming Control Board Use Only) FROM Independent Agents Name (Please Print) NOTE: IF INDEPENDENT AGENT IS MARRIED,
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Independent agents - gaming refer to individuals or entities who represent gaming companies in a non-employee capacity, such as affiliates or influencers.
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Information such as the names of the agents, their activities, commissions received, and any incentives provided by the gaming company must be reported on independent agents - gaming.
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